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UN Secretary General Koffi Annan
Photo: UN
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Every hour, two new AIDS cases are reported among people 25 and younger. Still, thanks to anecdotal evidence and to highly publicized cases of celebrities such as Magic Johnson, there is a growing perception among many Americans that HIV/AIDS is no longer the killer it once was.
And, in a sense, there is some truth to that. If you are tested regularly,
have access to the latest drugs and can maintain a rigorous program of up to
40 pills per day and endure their side effects, and are part of a
well-structured health care system, you can continue living for years after
contracting HIV. In short, if you live in a rich, western country, chances
are you will be able to get the help you need to live a longer life.
But the picture is far different in the world's developing countries, where
roughly 37 million people are currently infected with HIV or have full blown
AIDS, according to the United Nations.
In Sub-Saharan Africa, in particular, AIDS can only be described as a 21st
century plague. There, 28.1 million people are currently HIV positive. Last
year alone, 3.4 million adults and children in the region were newly infected
with HIV and 2.3 million died from AIDS-related causes. In some towns and
cities along the Zimbabwe-South Africa border, it is estimated that 70% of
all adults are HIV positive.
If current trends continue, HIV/AIDS will not just cause immeasurable anguish
and suffering among Africa's millions but could destabilize entire societies
as sizable percentages of their populations (doctors, teachers, truck
drivers, professors, government workers, business leaders, etc.) perish.
On the most superficial level, the solution to the world AIDS problem appears
relatively easy: simply take the drugs that slow the progress of HIV/AIDS in
humans available in developed nations and distribute them to poorer
countries.
But at stake in the current AIDS crisis are not just millions of lives but
millions of dollars and, according to some, a precedent that might impact the
rules of intellectual property and international trade for years to come.
The Basics of HIV/AIDS
Understanding the geopolitics which have allowed the current crisis to reach
such an unprecedented scale requires at least a basic knowledge of what HIV
and AIDS are, along with a primer in how the drugs that combat them work.
First of all, HIV doesn't kill people. It infects people's immune systems.
Bodies with significantly debilitated immune systems can die of infections
that healthy immune systems simply fight off (these include pneumonia, blood
stream infections, meningitis, and others). AIDS is a term used to describe
HIV infected people with immune systems that have been severely compromised.
To date, there is no cure for HIV. In other words, once HIV positive, always
HIV positive. However, there is currently a number of different drugs which,
when taken together in the right sequence and combinations around the clock,
can keep HIV suppressed. So suppressed, in fact, that many people have been
taking these drug 'cocktails' for years and have yet to develop AIDS.
But there are down sides to this treatment, which is also known as 'triple
therapy'. First, if a patient stops taking the drugs, even for one day, the
virus will rear its ugly head and start replicating again. Second, if a
patient goes back on triple therapy after stopping, the virus will have
mutated against it. Thus the patient has burned a bridge and that treatment
won't be effective ever again. Moreover, he or she now has a more
sophisticated version of the virus, which can be passed to others through
blood transfusions, sexual contact, or shared needles.
The Challenges to the Third World
So the challenge in poor countries isn't simply getting the right drugs into
the hands of people who need them but finding a way to make sure those people
take the drugs properly and consistently. For years, the big American and
European drug companies have contended that it is reckless to allow countries
with little or no health care systems to have access to their treatments
because they would not be administered correctly.
AIDS activists point to Brazil as a nation in the developing world, which had
a shabby health care infrastructure for years but whose government has
successfully administered triple therapy to citizens infected with HIV. As a
result, as of January, 2001, the rate at which Brazilians were dying from
AIDS related complications had dropped by half.
Conditions and infrastructures in most Sub-Saharan nations are inferior to
those in Brazil and doubts remain as to whether they will be able to oversee
the implementation of triple therapy on a mass scale without significant
outside assistance. There have, however, been some hopeful signs in recent
months. Two studies, conducted on volunteers in the African nations of
Senegal and the Ivory Coast, showed that triple therapy was effective, at
least on a small scale. The vast majority of those taking part in the survey
saw detectable levels of the virus recede significantly, a sign that they
were capable to sticking to the triple therapy regimen diligently.
Following the Money
Citing these studies, AIDS activists say that the big drug manufacturers'
reluctance to make their products readily available to developing countries
has more to do with minding their own bottom lines than with concerns over
public health. As the number of confirmed HIV cases has skyrocketed, nations
such as Brazil, Nigeria, Chile, India, and others have found themselves
increasingly at odds with multinational drug conglomerates such as Merck, Eli
Lilly, Roche, and Pfizer.
In countries such as the US, a year's dosage of triple therapy drugs costs
about $10,000. Pharmaceutical companies can charge such high prices because
they establish patents on the new treatments they develop that last 20 years.
During that time, no other company can make and sell that same drug. So,
when a manufacturer creates a drug for which there is very high demand, the
sky is almost the limit on how much it can charge.
Of course, the average per capita income for most citizens in the developing
world is less than $10,000 so there is no conceivable way they could afford
triple therapy at US prices. Nor can most developing nations' governments
afford to buy the drugs for their citizens at those prices because they too
are cash poor.
But it doesn't cost a drug company $10,000 to develop a year's worth of the
treatment. In fact, it isn't really known how much it costs them but one
thing is for sure -- it's a lot less than ten grand. (If it wasn't, they
wouldn't be profitable.)
So AIDS activists have demanded that the pharmaceutical firms make their
drugs available at cut rates to developing countries. Until recently, few
manufacturers had agreed. But led by Brazil, the developing countries have
found a way to the heat up on the pharmaceutical firms in the last few years.
The World Trade Organization is the worldwide body that coordinates and sets
rules for trade across the globe. Among the rules a country like Brazil must
abide by in order to be a member of the WTO is that it will respect
intellectual property patents established by companies in other WTO nations.
So, for example, Brazil must acknowledge that Roche is the only company on
earth that has the right to manufacture the drug Hivid. And the Brazilian
government must make sure that no other company in Brazil produces a drug
that does exactly what Hivid does. Since membership in the WTO is crucial to
developing nations that want to export their goods abroad, violation of the
rules is a risky gambit.
However, there is a clause in the WTO rules that states that in a health
emergency a member nation can ignore such patents. Citing that clause, that
is exactly what Brazil did several years ago. Working with drug makers in
their own country, the Brazilian government began producing the medicines
needed for triple therapy. Then, they began distributing them via a beefed
up health care infrastructure that the government helped put in place.
This infuriated the drug companies who worried that other countries would
follow suit and that their products would be produced and sold generically
all over the world. They pressured the US government and others to take
punitive steps against Brazil on their behalf.
But thanks at least in part to the increased attention the African AIDS
crisis has received in the media, it is the drug companies that have blinked.
Last December, ten African nations signed deals with pharmaceutical
companies that slashed triple therapy drug prices by 85%. In exchange, these
developed nations have agreed to monitor the drugs carefully to make sure
that their citizens don't, in turn, export the drugs back to the developed
world and sell them there for profit.
But not all the African nations got with the program. Nigeria, for example,
has made it clear that it intends to buy anti-retroviral drugs from an Indian
company for a price even lower than the ones agreed upon by the 10 other
nations. And local officials in South Africa have begun importing
generically produced drugs from Brazil.
For their part, the drug companies contend that their concerns are not profit
driven. They point out that sales of anti-HIV drugs make up a relatively
small portion of their annual revenues. They say they are more concerned
with maintaining the sanctity of intellectual property patents, which they
say are the cornerstone of their businesses and are responsible for the
extraordinary advances in drug technology.
They say that AIDS and other anti-drug company activists have over simplified
the economics of their industry when they claim the profits they earn on
existing drugs are too large. They point to the fact that developing a new
drug takes on average $500 million and 12 years to bring to market. To
develop the newest, most effective drugs, they say, they need to maximize
profits on existing products so they have more money to plow into research
and development. Allowing companies in Brazil and India to copy their product
sets a dangerous precedent that undercuts the entire system, they say.
Where the US Stands
Secretary of State Powell has been outspoken about the fact that he views the
dramatic rise in the number of AIDS cases as more than merely a health
crisis. AIDS is a national security problem. It is devastating problem in
Sub-Saharan Africa. It is a pandemic. It requires our attention, and
Congress has to be generous, he said last February.
AIDS activists, Secretary General Koffi Annan, British Prime Minister Tony
Blair, and others have all pointed out that a coordinated international
effort is needed to stanch the number of AIDS cases. For his part, the
president pledged $200 million in US to such a project during a Rose Garden
ceremony last Spring. But it is estimated that some $7-$10 billion will be
needed to begin to address seriously the problem. And so far, neither the US
nor its other developed world nations have come up with that kind of cash.
So the battles between developing nations and the pharmaceutical concerns are
likely to continue to rage on. And as they do, millions contract HIV and die
from AIDS across Africa, Asia, South America and elsewhere.
By Ethan Zindler
Tune into "Be Heard: An MTV Global Discussion With Colin Powell," premiering February 14 at 8 p.m. ET. Colin Powell answers your questions about world events during the show. Check the Weekly Schedule for encore air times.
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